Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 65,700,147 | 159,085,674 | 103,436,932 | 352,799 | 205,790 | 328,781,342 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | 308,674,577 | 496,510,565 | 487,069,252 | 496,591,493 | 505,042,643 | 2,293,888,530 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 374,374,724 | 655,596,239 | 590,506,184 | 496,944,292 | 505,248,433 | 2,622,669,872 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | 0 | 0 | 0 | 0 | 0 |
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public support. (Subtract line 7c from line 6.) | 2,622,669,872 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 374,374,724 | 655,596,239 | 590,506,184 | 496,944,292 | 505,248,433 | 2,622,669,872 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 41,832 | 616,212 | 686,938 | 645,695 | 252,646 | 2,243,323 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 41,832 | 616,212 | 686,938 | 645,695 | 252,646 | 2,243,323 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | 0 | 0 | 0 | 0 | 0 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 374,416,556 | 656,212,451 | 591,193,122 | 497,589,987 | 505,501,079 | 2,624,913,195 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 15000238 |
| Software Version: | 2015v3.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4 program service accomplishments | Community Benefit Overview St. Vincent Medical Group, Inc. is part of St. Vincent Health, a non-profit healthcare system consisting of 20 locally-sponsored ministries serving over 57 counties throughout Central Indiana. Sponsored by Ascension Health, the nation's largest Catholic healthcare system, St. Vincent Health is one of the largest healthcare employers in the state. As part of St. Vincent Health, the St. Vincent Medical Group, Inc.'s vision is to deliver a continuum of holistic, high-quality health services and improve the lives and health of Indiana individuals and communities, with special attention to the poor and vulnerable. This is accomplished through strong partnerships with businesses, community organizations, local, state and federal government, physicians, St. Vincent associates and others. Working with its partners, and utilizing the CHNA completed every three years, St. Vincent Medical Group, Inc. is committed to addressing community health needs and developing and executing an implementation strategy to meet identified needs to improve health outcomes within the community. Community benefit is not the work of a single department or group within St. Vincent Medical Group, Inc. but is part of the St. Vincent mission and cultural fabric. The hospital leadership team provides direction and resources in developing and executing the Implementation Strategy in conjunction with the St. Vincent Health Community Development & Health Improvement Department, but associates at all levels of the organization contribute to community benefit and health improvement. Charity Care and Certain Other Community Benefits at Cost Patient Services for Poor and Vulnerable Hospital and outpatient care is provided to patients that cannot pay for services, including hospitalizations, surgeries, prescription drugs, medical equipment and medical supplies. Patients with income less than or equal to 250% of the Federal Poverty level (FPL) will be eligible for 100% charity care write off on that portion of the charges for services for which the patient is responsible following payment by an insurer, if any. At a minimum, patients with incomes above 250% of the FPL, but not exceeding 400% of the FPL, will receive a sliding scale discount on that portion of the charges for services provided for which the patient is responsible following payment by an insurer, if any. A patient eligible for the sliding scale discount will not be charged more than the calculated AGB (amounts generally billed) charges. Patients with demonstrated financial needs with income greater than 400% of the FPL may be eligible for consideration under a "Means Test" for some discount of their charges for services from the organization based on a substantive assessment of their ability to pay. Maximum owed by any patient per episode of care or account is 10% of gross household income. Hospital financial counselors and health access workers assist patients in determining eligibility and in completing necessary documentation. St. Vincent Medical Group, Inc. is committed to 100% access, and is proactive in providing healthcare that leaves no one behind. Public Program Participation St. Vincent Medical Group, Inc. participates in government programs including Medicaid, SCHIP (Hoosier Healthwise), Healthy Indiana Plan (HIP), the Health Insurance Marketplace and Medicare and assists patients in enrolling for programs for which they are eligible. Per Catholic Health Association guidelines and St. Vincent's conservative approach, Medicare shortfall is not included as community benefit. Rural and Urban Access to Health (RUAH) As part of its commitment to 100% access, nine St. Vincent ministries participate in Rural and Urban Access to Health (RUAH), a community based care coordination program. Effective care coordination provides a strategy for addressing certain social determinants of health by assuring barriers to care are addressed and individuals are connected to critical prevention and treatment services. Started in 2000, the program operates in St.Vincent hospitals in Clay, Clinton, Fountain/Warren, Hamilton, Howard, Jennings, Madison, Randolph, Washington counties in conjunction with nine St.Vincent hospitals. Central to the program are Health Access Workers who help clients/patients by connecting them with a medical home, assisting with enrollment in public programs for which they qualify, identifying and removing barriers to services, and referring them to other community resources as needed; Medication Assistance Coordinators who connect clients with low- or no-cost medications for which they qualify using a sophisticated database that St.Vincent provides; and Language Access Services which ensures that St.Vincent Health ministries are in compliance with CLAS (Culturally and Linguistically Appropriate Services) standards, and that trained medical interpreters and other language resources are available, ensuring access to care. RUAH outcomes are measured using the Pathways Model as a means of tracking interventions and improving accountability towards positive measurable changes in patients' lives. Five pathways/protocols are now available: enrollment, medical home, medical referral, pregnancy and social service. The Pathways identify the evidence-based steps needed to produce a successful outcome. During fiscal year 2016, the Health Access Workers completed 5,901 pathways. RUAH Medication Coordinators assisted community members in accessing 3,319 low/no cost medications valued at $3,983,210 million dollars (average wholesale price.) Blood Pressure Clinic St. Vincent Medical Group, Inc. offers blood pressure clinics free to the public at various locations each month to educate individuals on the importance of controlling their blood pressure. Uncontrolled high blood pressure can increase a person's risk for heart disease, kidney failure, stroke, and blindness. Associates educate individuals how to measure and track their blood pressure readings to help them live healthier lives. During fiscal year 2016, associates assisted over 550 individuals. Health Fairs and Screenings St. Vincent Medical Group, Inc.'s physicians, nurses and associates participated in a variety of community health events including Kids Safety Day. Screenings were held in conjunction with schools, such as West Washington and Salem schools. These events provided invaluable health education, prevention and screenings for thousands of Hoosiers across the state free of charge. During fiscal year 2016, over 180 individuals attended health fairs. Community Health & Wellness Center St. Vincent Medical Group, Inc. sponsors the Community Health & Wellness Center, which provides needed healthcare and support to those in the community with little or no insurance. The Center serves all residents of Lawrence County and surrounding areas. Services include: obstetrics/gynecology, pediatrics, and adult primary care. The center is also a WIC site which provides nutrition education, health screenings, and health assessments, as well as counseling to pregnant women and children. Community Health Boards St. Vincent Medical Group, Inc. staff participates on boards which focused on issues that affect the health and quality of life for the most vulnerable in the community. These boards are addressing issues such as heroin addiction and child abuse. Food Security According to Feeding America, 15.3% of the population in Indiana is considered food insecure, and therefore, struggle with the ability to provide enough food for every person in the household to have an active, healthy life. St. Vincent Medical Group has addressed food insecurity in a variety of ways, including donations of staff time to Gleaners Food Bank, which serves central Indiana. Additionally, with the understanding that food insecurity exists within every community, staff worked at the International Disaster Emergency Services assembling meals for Afghanistan villages. Community Benefit Cash and In-Kind Contributions In addition to the outreach programs directly operated by St. Vincent Health, the corporate office and physician network makes cash and in-kind donations to a variety of community organizations focused on improving health status in the community. These take the form of cash donations to outside organizations, the donation of employee time and services to outside organizations and the representation of the hospital on community boards and committees working to improve health status and quality of life within the community. |
| Form 990, Part III, Line 4 program service accomplishments | Community Building Activities St. Vincent Medical Group, Inc. makes cash and in-kind donations to a variety of community organizations focused on building the community. These take the form of cash donations to outside organizations, the donation of employee time and services to outside organizations and the representation of the organization on community boards and committees working to improve infrastructure for the community. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | St. Vincent Medical Group, Inc. has a single corporate member, St. Vincent Health, Inc. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | St. Vincent Medical Group, Inc. has a single corporate member, St. Vincent Health, Inc. who has the ability to elect members to the governing body of St. Vincent Medical Group, Inc. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | All decisions that have a material impact to St. Vincent Medical Group, Inc.'s financial information or corporation as a whole are subject to approval by its sole corporate member, St. Vincent Health, Inc. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form 990 to a designated committee of the Board to review and answer any questions. Prior to filing the returns, all Board members are provided the Form 990 and management team members are available to answer any Board member questions. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committee with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax exempt purpose. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | Compensation determinations of St. Vincent Medical Group, Inc.'s CEO, executive director, or top management official are made by St. Vincent Health, Inc.'s management. The process includes a review and approval by independent persons and comparability data. In review of the compensation, the CEO, executive director, and top management were compared to other hospitals in the area that hold the same position. Compensation determinations of St. Vincent Medical Group, Inc.'s other officers or key employees are made by St. Vincent Medical Group, Inc.'s management. In determining compensation of other officers or key employees of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review of the compensation, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same position. |
| Form 990, Part VI, Line 19 Required documents available to the public | The organization will provide any documents open to public inspection upon request. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Transfer (to) from Affiliates - XXX-XX-XXXX; |
| Software ID: | 15000238 |
| Software Version: | 2015v3.0 |